血清炎症因子水平在血流感染性疾病中的表达及与病原菌、病情程度及预后的相关性研究

Expression levels of serum inflammatory cytokines in blood infectious diseases and their correlations with pathogenic bacteria, disease severity and prognosis

摘要:

目的探讨血清炎症因子表达水平在血流感染性疾病中与病原菌、病情程度及预后的相关性。方法采用回顾性分析2015年1月-2016年5 月该院收治的97 例血流感染性疾病患者作为研究对象，根据患者病情、病原菌种类及治疗效果等来分析血清炎性因子降钙素原（PCT）、C- 反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞数（WBC）及肿瘤坏死因子α（TNF-α）的表达水平在血流感染性疾病中的变化。结果血培养阳性的血流感染性疾病患者的血清炎症因子水平普遍高于血培养阴性患者的血清炎症因子水平，两者比较差异有统计 学意义[PCT（t =170.410，p=0.000）；IL-6（t =187.223，p=0.000）；WBC（t =19.244，p=0.000）；CRP（t =47.941，p=0.000）；TNF-α（t =20.484，p =0.000）]；血清炎症因子PCT、IL-6、WBC、CRP 及TNF-α 表达水平在革兰阴性菌组中最高，真菌组最低，三者间比较差异有统计学意义[PCT（F =5.367，P=0.019）；IL-6（F =10.321，P=0.001）；WBC（F =9.587，P =0.000）；CRP（F =15.894，P =0.000）；TNF-α（F =13.254， P=0.000）]；各组血清炎症因子表达水平有差异，进一步两两比较，差异有统计学意义（P <0.05）。治疗无效的血流感染性疾病患者的血清炎症因子表达水平均升高，治疗前后两者比较差异有统计学意义（P <0.05）；治疗好转的血流感染性疾病患者血清炎症因子表达水平均下降，治疗前后两者比较差异有统计学意义（P <0.05）。治疗好转组与治疗无效组血流感染性疾病患者的血清炎性因子表达水平在治疗前后差值比较，差异有统计学意义（P <0.05）。结论血清炎性因子表达水平与血流感染性疾病的严重程度、病原菌种类等有一定相关性，对治疗效果的早期判断有一定参考价值。

Abstract:

Objective To explore the correlations between expression levels of serum inflammatory cytokines and pathogens, degree of disease and prognosis in blood infectious diseases. Methods A total of 97 cases of bloodstream infections were included in this retrospective analysis from January 2015 to May 2016.The expression levels of procalcitonin (PCT), C-reactive protein (CRP), interleukin 6 (IL-6), white blood cell count (WBC) and tumor necrosis factor alpha (TNF-α) were analyzed according to patients' condition, types of pathogenic bacteria, and treatment effect. Results The levels of serum inflammatory cytokines of patients with positive blood culture were significantly higher than those with negative blood culture, the differences were statistically significant [PCT (t = 170.410,p = 0.000); IL-6 (t = 187.223,p = 0.000); WBC (t = 19.244,p = 0.000);CRP (t = 47.941, p= 0.000); TNF-α(t = 20.484,p = 0.000) ]. The levels of serum inflammatory factors PCT, IL-6,WBC, CRP and TNF-α were the highest in Gram-negative bacteria group, and the lowest in fungus group, of which the differences were statistically significant [PCT (F = 5.367,P = 0.019); IL-6 (F = 10.321,P = 0.001); WBC(F = 9.587,P = 0.000); CRP (F = 15.894,P = 0.000); TNF-α(F = 13.254,P = 0.000) ]. There was significant difference between each compared group (P < 0.05). Expression levels of serum inflammatory cytokines of blood flow infected patients in the ineffective group were significantly increased. There was significant difference between preand post-treatment group (P < 0.05). Serum inflammatory cytokine expression levels of bloodstream infected patients in the effective group were significantly decreased, there was significant difference between the two groups (P <0.05). Expression levels of serum inflammatory cytokines of blood flow infected patients were significantly different between the effective and the ineffective groups (P < 0.05). Conclusions There are some correlations between the expression levels of serum inflammatory cytokines and the severity of blood infectious diseases or pathogenic bacteria species, which is of some value to early judgment of therapeutic effect.